Thorax 1999;54:316-322 ( April )

Effect of inhaled corticosteroids on bronchial responsiveness in patients with "corticosteroid naive" mild asthma: a meta-analysis

P M van Grunsven,^a C P van Schayck,^a J Molema,^b R P Akkermans,^a C van Weel^a

^a Department of General Practice and Social Medicine, ^b Department of Pulmonology, Dekkerswald, ^c University of Nijmegen, P O Box 9101, 6500 HB Nijmegen, The Netherlands

Correspondence to: Dr P M van Grunsven.

Received 23 February 1998; Returned to authors 25 June 1998; Revised version received 19 October 1998; Accepted for publication 11 December 1998

BACKGROUNDInhaled corticosteroids are the most efficacious anti-inflammatory drugs in asthma. International guidelines also advocate the early introduction of inhaled corticosteroids in corticosteroid naive patients. A study was undertaken to assess the effects of inhaled corticosteroids on bronchial hyperresponsiveness in patients with corticosteroid naive asthma by conventional meta-analysis.
METHODSA Medline search of papers published between January 1966 and June 1998 was performed and 11 papers were selected in which the patients had no history of treatment with inhaled or oral corticosteroids. Bronchial responsiveness to bronchoconstricting agents was considered as the main outcome parameter. Doubling doses (DD) of histamine or methacholine were calculated.
RESULTSThe total effect size of inhaled corticosteroids (average daily dose 1000 µg) versus placebo in the 11 studies was +1.16 DD (95% confidence interval (CI) +0.76 to +1.57). When only the eight short term studies (2-8 weeks) were analysed the effect size of the bronchoconstricting agent was +0.91 DD (95% CI +0.65 to +1.16). No relationship was found between the dose of inhaled corticosteroid used and the effect on bronchial responsiveness.
CONCLUSIONThis meta-analysis in patients with corticosteroid naive asthma indicates that, on average, high doses of inhaled corticosteroids decrease bronchial hyperresponsiveness in 2-8 weeks. It remains unclear whether there is a dose-response relationship between inhaled corticosteroids and effect on bronchial hyperresponsiveness.

Keywords: inhaled corticosteroids; corticosteroid naive asthma; bronchial hyperresponsiveness

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© 1999 by Thorax
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